Melanomas are a type of cancer that develops in skin cells called melanocytes. Melanoma cancers have a typical appearance of blotchy, dark patches but can actually look like any type of mole, spot, or dark blotch. Because of this sneaky appearance and its quick metastatic spread, melanoma is the deadliest type of skin cancer – it represents 2% of all skin cancers but is responsible for 75% of skin cancer deaths. Australia and New Zealand have the highest rates of melanoma in the world and it's estimated that five Australians die from melanoma each day [1].

The good news is that melanoma skin cancers can be simply removed and stopped in their tracks if they are detected early in their development.

What To Look For

As with all cancers, early detection is the number one predictor of survival.

Melanomas grow outwards to begin with and then spread deeper into the body to find a blood supply – more advanced melanomas affect the lymph nodes and can spread to organs.

Melanoma often presents with no symptoms except for changes in an existing mole or the appearance of a new, strange looking spot [2].

Get your moles checked by a doctor if you notice any of these changes:

• Size – If the mole appears to get bigger
• Shape – Especially if the mole has an irregular border
• Height – If the mole appears to grow “taller”, or if the area is elevated
• Colour – If the mole changes colour, has different shades, or becomes blotchy
• Sensation – If the mole itches or bleeds
• New spots – If a new mole appears during adulthood. Note that it is normal to develop new moles in childhood, adolescence and during pregnancy. [3]

Men are most likely to develop melanoma on their backs and women are more likely to find these nasty spots on their legs – but it's important to note that they can grow anywhere. While melanomas typically present on the skin as moles, they can also occur inside the mouth, vagina, anus, or under the nail beds [2]. Speak to your doctor if you or your partner have noticed any dark spots in these areas.

Two Major Causes of Melanoma

UV Radiation

Skin cells absorb UVA and UVB rays and the ultraviolet radiation directly damages the cell's DNA. This kind of damage results in cell mutation where the melanocytes begin to grow out-of-control.

Extreme, intermittent sun exposure seems to increase the risk of a melanoma – the kind of exposure where you get a severe sunburn and spend the rest of summer indoors applying aloe vera gel while your skin peels off!

Not only is that a disappointing and painful way to spend the warmer months, but each sunburn does cumulative damage – each burn increases the likelihood that the following sunburn will develop a melanoma.

UV radiation is highest closest to the equator and in the air – people who work in airplanes are at high risk of developing skin cancers.

REMEMBER: It's not just our great fireball sun that omits UV radiation – tanning beds are a leading cause of skin cancer. People who have used tanning beds before the age of 30 are 75% more likely to develop melanoma skin cancers! [4]

Genetics

People with fair skin are the most susceptible to UV damage. As well as skin tone, melanoma may run in the family. Some genetic mutations that increase the risk of developing this deadly skin cancer can be passed down through generations. These gene mutations are rare and most commonly present in people who have red hair, or are born with multiple unusual moles. But having any family member with melanoma also increases your risk [2].

Preventing Melanoma

Limit Intentional Sun Exposure

Here's what it comes down to – UV rays are constantly absorbed by the skin and the more time intentionally spent in the sun, the higher the risk of skin cancer [5].

If you're going out in the sun, keep it brief and remember to Slip Slop Slap! Covering up is still the number one preventative measure to reduce the risk of melanoma when in the sun.

There has been some controversial debate over the use of sunscreen – the take-away is that sunscreen can prevent melanoma but that depends on how you use it.

If you're planning on spending a day in the sun, be aware the no amount of sunscreen will protect you from UV radiation and melanoma risk – even high SPF sunscreen doesn't protect against skin cancer during intentional sun exposure [5].

Vitamin D & Sunscreen

One common controversial opinion about sunscreen is that it can lead to a vitamin D deficiency. Vitamin D is created in the skin when it reacts with sunlight and sunscreen is said to inhibit this process. All of the current evidence suggests this is not the case. Vitamin D synthesis reaches its maximum capacity within minutes of sun exposure, and after that it begins to be broken down by the sun [6]. If anything, sunscreen may help to preserve vitamin D levels! If you are worried about your vitamin D status, get it checked regularly, increase your dietary intake, and take a supplement if necessary.

Profession

If radiation from the sun is the leading risk for skin cancer, then people who spend more time indoors should be safe, right? Strangely, the opposite may be true. People who work outdoors, such as tradesmen, are statistically less likely to develop melanoma that those who work indoors in office environments [2]. This might be because of their sun safety habits!

The Latest Sun Safety Tips

• ​Do NOT use sunscreen as a way to extend your time in the sun – this is a recipe for sunburn.
   
• Cover-up and get out of the sun immediately if you experience redness, itchiness or soreness from the sun. No matter how long you've been out, whether you're wearing sunscreen, or if you're intentionally in the sun or not - this is a sign that your skin is being damaged. Don't just put on more sunscreen – find some shade or go indoors!
• Be sure to use broad spectrum UVB & UVA sunscreen. Having protection against UVB rays is great, but you'll still get a sunburn if you're left susceptible to UVA radiation.
   
• Hats, shirts and clothing are a great way to protect yourself against UV radiation and have the best results when combined with sunscreen.
   
• If you're at high risk of melanoma, apply broad spectrum sunscreen every day to all body parts that are exposed to the sun.   [2] [7]

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References

[1]  Australian Institute of Health and Welfare (2017) Cancer in Australia 2017. https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2017/contents/table-of-contents  

[2] Rastrelli, M., et al. (2014) Melanoma: Epidemiology, Risk Factors, Pathogenesis, Diagnosis and Classification. In Vivo, 28:6, 1005 – 1011. http://iv.iiarjournals.org/content/28/6/1005.long

[3] Goodson, A. G. & Grossman, D. (2009) Strategies for early melanoma detection: approaches to the patient with nevi. J Am Acad Dermatol., 60:5, 719 – 738. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690513/

[4] LeClaire, M. Z. & Cockburn, M. G. (2016) Tanning bed use and melanoma: Establishing risk and improving prevention interventions. Prev Med Rep., 3, 139 – 144. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929140/

[5] Autier, P. (2000) Do high factor Sunscreens offer protection from melanoma ? West J Med., 173:1, 58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070981/

[6] Harris, S. S. & Dawson-Hughes, B. (2007) Reduced Sun Exposure Does Not Explain the Inverse Association of 25-Hydroxyvitamin D with Percent Body Fat in Older Adults. The Journal of Clinical Endocrinology & Metabolism, 92:8, 3155 – 3157. https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2007-0722

[7] Planta, M. B. (2011) Sunscreen and Melanoma: Is Our Prevention Message Correct? J Am Board Fam Med., 24:6, 735 – 739. http://www.jabfm.org/content/24/6/735.long